1699023028 NPI number — MS. VICKIE L HERMANN LICSW, LLC

Table of content: MS. VICKIE L HERMANN LICSW, LLC (NPI 1699023028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699023028 NPI number — MS. VICKIE L HERMANN LICSW, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERMANN
Provider First Name:
VICKIE
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW, LLC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699023028
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 SE 124TH AVE
Provider Second Line Business Mailing Address:
SUITE 10
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98684
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-606-9678
Provider Business Mailing Address Fax Number:
360-885-4944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 SE 124TH AVE
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-606-9678
Provider Business Practice Location Address Fax Number:
360-885-4944
Provider Enumeration Date:
08/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LW 60265048 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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